Implementation, process, and outcomes of nutrition best practices for infants <1500 g

Background: Extrauterine growth restriction (EUGR; weight ≤10th percentile) affects many infants ≤1500 g birth weight (BW). EUGR is associated with poor neurodevelopmental outcomes. The objective of this study was to evaluate the impact of optimizing nutrition administration in infants ≤1500 g. Methods: A retrospective chart review compared infants ≤1500 g before (n = 32) and after (n = 49) implementation of nutrition practice changes designed to decrease EUGR. Changes included early aggressive parenteral nutrition (PN), early enteral feedings, trophic feedings, continuous feeding administration, protein fortification of 24-cal/oz mother's own breast milk, and development of a "feeding intolerance" algorithm. The authors evaluated demographics, growth parameters, secondary feeding, and discharge outcomes. Differences in subgroups of infants ≤1000 g and 1000-1500 g BW were assessed. Results: Implementation of the nutrition practice changes decreased EUGR as defined by weight ≤10th percentile at discharge from 57% in the preimplementation group to 28% in the postimplementation group (P =.01). Weight percentile ranking at 36 weeks' gestational age increased significantly in infants 1001-1500 g, from the 13th to the 27th percentile (P =.004 and P =.01, respectively). Chronic lung disease decreased significantly (P =.02). There was no increase in necrotizing enterocolitis (6% pre vs 3% post) or in blood urea nitrogen. Days of PN and central line use were decreased (P =.02 and P =.07, respectively). Conclusions: Clearly defined changes in nutrition for infants ≤1500 g significantly improved growth outcomes without increasing undesired outcomes.